Fascinating that there were school shootings in the 19th century. I'd thought the first one was in the 50s.
In any case, it seems very clear that the explosion in school shootings in recent decades has nothing to do with guns (which were always there) and everything to do with the pathogenic circumstances of modernity. But addressing the latter, also implicated in e.g. the dramatic growth in the abuse of prescription and recreational chemicals, would require asking questions about social organization. And no one with power wants to do that.
I had the thought while writing this post that the school shooter types are like canaries in the coal mine. They're already predisposed to sense a lack of meaning in their lives and the world, and take their "solutions" to extremes. Generalized conditions of spiritual decline probably exacerbates their misery, which makes their solutions even more destructive.
Social isolation seems to be a big factor almost independent of sub-type. In a more connected, organic society, they'd probably get just enough love to keep them from going off the deep end. When society gets atomized, the edge cases are the first to go nuts.
Great article Harrison - I haven’t yet but will watch the videos - thanks for highlighting them!
In my experience the distinction between DSM categories with real clients can be rather blurry, nevertheless I understand and appreciate the definitions - giving us solid points of reference from which we can sensibly talk about such pathologies, while accepting the often dynamic blurry edges that living beings inevitably display.
And congratulations again on the notes in PP - a remarkable effort that really brings an important dimension to this latest edition. I’m probably not mistaken in assuming such work could have produced a book on its own! (I guess you can tell you have a fan in me!)
Thanks, Winston. One of my pre-publication readers also suggested the notes could make their own book (we deleted some that were too long or tangential, so I'll be using some of those in future posts - already included a couple in this post).
Re: DSM diagnoses, I agree. I fluctuate between finding the DSM PDs helpful to a degree, but also probably fundamentally wrong in some ways. I think a Big Five approach, like what they've started using in the ICD, is probably somewhat better. The problem of comorbidity is a big one, which the five factor approach attempts to get around. You've probably seen some of the notes on that subject in PP. Guys like Tyrer advocate a general diagnosis of "personality disorder" of varying severities, with five different dimensions (detachment, neg. emotion, disinhibition, psychoticism, antagonism - which map to 4 of the 5 personality factors). This can account for the existing DSM PDs, but with other combinations too.
Dr. Grande kind of takes that approach in his videos, but still uses DSM diagnoses as a basis. As a kind of shorthand, I tried to determine what might be the core pathological dimension(s) of PDs that distinguish them from their close cousins. E.g., histrionic = pathological extraversion, OCPD and antisocial = different poles of pathological conscientiousness, schizoid = pathological introversion and low neuroticism, schizotypal = pathological introversion and high neuroticism, borderline = pathological neuroticism perhaps, and psychopathy as pathological disagreeableness and low neuroticism.
So instead of having comorbid PDs, you could use various shorthands. Like, schizotypal could be "schizoid" (detached) with neurotic/psychotic features.
A sensible approach I think and probably closer to the original intention of the DSM (devising a common language of symptoms for researchers across disciplines) rather than a hard and fast diagnostic tool in the service of funding bodies, insurance companies and big pharma.
I'm not in practice any more, but when I was, I'd write notes in a similar manner - making comment about features described in the DSM but in a mix-&-match fashion, as presentations almost never would fit neatly into just one diagnosis (of course if you approach patients with the expectation of them fitting within a primary diagnosis, you will often find what you are looking for. If you are more open, without this agenda, then the picture often emerges as more complex and like fractal boundaries, never clearly delineated - and we know which hemisphere can't handle such a situation :-) )
Psychiatric medication has completely destroyed my life and crippled me. I'm off all Psychiatric medication and now I'm left with permanent neurological effects, F*** those drugs anyone promoting that garbage. That shit should be banned from ever being prescribed to children.
Fascinating that there were school shootings in the 19th century. I'd thought the first one was in the 50s.
In any case, it seems very clear that the explosion in school shootings in recent decades has nothing to do with guns (which were always there) and everything to do with the pathogenic circumstances of modernity. But addressing the latter, also implicated in e.g. the dramatic growth in the abuse of prescription and recreational chemicals, would require asking questions about social organization. And no one with power wants to do that.
I had the thought while writing this post that the school shooter types are like canaries in the coal mine. They're already predisposed to sense a lack of meaning in their lives and the world, and take their "solutions" to extremes. Generalized conditions of spiritual decline probably exacerbates their misery, which makes their solutions even more destructive.
Social isolation seems to be a big factor almost independent of sub-type. In a more connected, organic society, they'd probably get just enough love to keep them from going off the deep end. When society gets atomized, the edge cases are the first to go nuts.
Great article Harrison - I haven’t yet but will watch the videos - thanks for highlighting them!
In my experience the distinction between DSM categories with real clients can be rather blurry, nevertheless I understand and appreciate the definitions - giving us solid points of reference from which we can sensibly talk about such pathologies, while accepting the often dynamic blurry edges that living beings inevitably display.
And congratulations again on the notes in PP - a remarkable effort that really brings an important dimension to this latest edition. I’m probably not mistaken in assuming such work could have produced a book on its own! (I guess you can tell you have a fan in me!)
Thanks, Winston. One of my pre-publication readers also suggested the notes could make their own book (we deleted some that were too long or tangential, so I'll be using some of those in future posts - already included a couple in this post).
Re: DSM diagnoses, I agree. I fluctuate between finding the DSM PDs helpful to a degree, but also probably fundamentally wrong in some ways. I think a Big Five approach, like what they've started using in the ICD, is probably somewhat better. The problem of comorbidity is a big one, which the five factor approach attempts to get around. You've probably seen some of the notes on that subject in PP. Guys like Tyrer advocate a general diagnosis of "personality disorder" of varying severities, with five different dimensions (detachment, neg. emotion, disinhibition, psychoticism, antagonism - which map to 4 of the 5 personality factors). This can account for the existing DSM PDs, but with other combinations too.
Dr. Grande kind of takes that approach in his videos, but still uses DSM diagnoses as a basis. As a kind of shorthand, I tried to determine what might be the core pathological dimension(s) of PDs that distinguish them from their close cousins. E.g., histrionic = pathological extraversion, OCPD and antisocial = different poles of pathological conscientiousness, schizoid = pathological introversion and low neuroticism, schizotypal = pathological introversion and high neuroticism, borderline = pathological neuroticism perhaps, and psychopathy as pathological disagreeableness and low neuroticism.
So instead of having comorbid PDs, you could use various shorthands. Like, schizotypal could be "schizoid" (detached) with neurotic/psychotic features.
A sensible approach I think and probably closer to the original intention of the DSM (devising a common language of symptoms for researchers across disciplines) rather than a hard and fast diagnostic tool in the service of funding bodies, insurance companies and big pharma.
I'm not in practice any more, but when I was, I'd write notes in a similar manner - making comment about features described in the DSM but in a mix-&-match fashion, as presentations almost never would fit neatly into just one diagnosis (of course if you approach patients with the expectation of them fitting within a primary diagnosis, you will often find what you are looking for. If you are more open, without this agenda, then the picture often emerges as more complex and like fractal boundaries, never clearly delineated - and we know which hemisphere can't handle such a situation :-) )
"Blessliefore" has to be the strangest typo I've ever come across (I assume it's a typo - no hits on Google, which is ... impressive!)
LOL. Fixed. Anticlimactic back story: I edited the post to rephrase a small bit and hit ctrl-F, then attempted to type "less likely." Didn't work.
Psychiatric medication has completely destroyed my life and crippled me. I'm off all Psychiatric medication and now I'm left with permanent neurological effects, F*** those drugs anyone promoting that garbage. That shit should be banned from ever being prescribed to children.